Hüseyin Can TÜKEL, Mehmet Emre BENLİDAYI

Mandibula kırıklarının prevalansı, tedavisi ve komplikasyonları

Amaç:Bu çalışmanın amacı Çukurova Üniversitesi Diş Hekimliği Fakültesi Ağız, Diş ve Çene Cerrahisi tarafından 2015-2017 yılları arasında tedavi edilen mandibula kırıklarının prevalansı, tedavisi ve komplikasyonlarını incelemektir. Gereç ve Yöntem:Mandibula kırıkları etiyolojiye ve kırıkların lokalizasyonuna göre sınıflandırıldı. Açık redüksiyon ve internal fiksasyon 2.0mm veya 2.4mm fiksasyon sistemleri kullanılarak yapıldı. Kapalı redüksiyonda ark-bar, intermaksiller fiksasyon vidaları veya tel-kompozit splint kullanıldı. Aşağıdaki komplikasyonlar kaydedildi: Geçici parestezi, kalıcı parestezi, maloklüzyon, enfeksiyon, temporomandibular eklem bozukluğu,fiksasyon materyalinin açığa çıkması ve kök hasarı.Bulgular:Ortalama hasta yaşı 32,8±(13,8) idi. Erkekler, çalışmaya dahil edilen vakaların %77.4(n = 65), kadınlar ise % 22.6(n=19) 'sını oluşturdu. Bu çalışmada mandibula kırıklarının nedenleri sırasıyla kişilerarası şiddet(27 olgu,%32,1), trafik kazaları(22 olgu,%26,2) ve düşme (21 olgu,% 25) olarak bulundu. Kırıkların en nadir nedeni spor kazasıydı (6 olgu,% 7,1). En yaygın kırık lokalizasyonu sırasıyla kondil(27,%24.5), ardından angulus (24,% 21,8), korpus (19,%17.3), simfiz / parasimfiz (18,% 16,4) ve alveolar kemik (17, %15,5) idi. Elli hasta açık redüksiyon (% 59,5) ile tedavi edilirken, 29 hasta kapalı redüksiyon (%34.5) ile tedavi edildi. Üç hasta (%3,6) tedavi görmedi. Hastaların 25'inde (%29,7) değişen derecelerde komplikasyonlar gözlendi. Bu çalışmada en sık rastlanan komplikasyon geçici parestezi (%13,1) olmuştur. Bunu temporomandibular eklem rahatsızlığı (%6,0) izlemiştir. Diğer komplikasyonlar seyrek görülmüştür.Sonuç:Farklı merkezlerin hastalarını farklı sosyo-ekonomik bölgelerde ve farklı klinik imkan / kaynak düzeylerinde nasıl yönettiğini anlamak ve güncel tedavi yöntemlerini takip etmek önemlidir. Mandibular kırıkların görülme sıklığı ve nedenleri, toplum içindeki travma modellerini yansıtması açısından daha iyi sağlık politikası stratejileri yürütmek için yol gösterici olabilir.

Anahtar Kelimeler:

Mandibula, alt çene, kırık, fraktür, maksillofasiyal, travma

Prevalence, treatment and complications of mandibular fractures

Purpose: The purpose of this study was to review and analyze the prevalence, treatment, and complications of mandibular fractures managed by the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Çukurova University between March 2015 and March 2017Materials and Methods: Mandibular fractures were sorted by etiology and fracture location. Open reduction and internal fixation of mandibular fractures were performed using 2.0mm or 2.4mm fixation systems. Closed reduction of fractures was performed using arch bars, intermaxillary fixation screws or wire-composite splints. The following complications were recorded: Temporary paresthesia, permanent paresthesia, malocclusion, infection, temporomandibular joint disorder, plate exposure and root damage.Results: The mean patient age was 32.8±(13.8). Males constituted 77.4%(n=65) and females constituted 22.6%(n=19) of the patients. The most common cause of mandibular fractures in this study was interpersonal violence (27 cases,32.1%), followed by road traffic accidents(22 cases, 26.2%) and falls(21 cases,25%). The least common cause of fractures was sports accident(6 cases,7.1%). The most common fracture localization was the condyle(27,24.5%), followed by the angle (24,21.8%), body (19,17.3%), symphysis/parasymphysis (18, 16.4%) and alveolar bone (17,15.5%). Fifty patients were treated by ORIF (59.5%), 29 patients were treated by closed reduction (34.5%). Complications in varying severity were observed in 25(29.7%) patients. The most common complication in this study was temporary paresthesia(13.1%) followed by TMD(6.0%). Other complications were seen infrequently.Conclusion: It is important to follow contemporary trends to understand how different centers manage their patients in different socio-economic regions and different levels of clinical facilities/resources. The incidence and causes of mandibular fractures may reflect the trauma patterns within the community, which is important for conducting better health policy strategies.

Keywords:

Mandible, maxillofacial, trauma,

PDF

___

1. Simsek S, Simsek B, Abubaker AO, Laskin DM. A comparative study of mandibular fractures in the United States and Turkey. Int J Oral Max Surg. 2007;36:395-7
2. Samieirad S, Tohidi E, Shahidi-Payam A, Hashemipour MA, Abedini A. Retrospective study maxillofacial fractures epidemiology and treatment plans in Southeast of Iran. Med Oral Patol Oral. 2015;20:E729-E736.
3. Samieirad S, Aboutorabzade MR, Tohidi E, Shaban B, Khalife H, Hashemipour MA, et al. Maxillofacial fracture epidemiology and treatment plans in the Northeast of Iran: A retrospective study. Med Oral Patol Oral. 2017;22:E616-E624.
4. Ogundare BO, Bonnick A, Bayley N. Pattern of mandibular fractures in an urban major trauma center. J Oral Maxil Surg. 2003;61:713-8.
5. Krishnaraj S, Chinnasamy R. A 4-year retrospective study of mandibular fractures in a south Indian city. J Craniofac Surg. 2007;18:776-80.
6. Erol B, Tanrikulu R, Gorgun B. Maxillofacial fractures. Analysis of demographic distribution and treatment in 2901 patients (25-year experience). J Craniomaxillofac Surg. 2004;32:308-13.
7. Ellis E, 3rd, Moos KF, el-Attar A. Ten years of mandibular fractures: an analysis of 2,137 cases. Oral Surg Oral Med Oral Pathol. 1985;59:120-9.
8. Atilgan S, Erol B, Yaman F, Yilmaz N, Ucan MC. Mandibular fractures: a comparative analysis between young and adult patients in the southeast region of Turkey. J Appl Oral Sci. 2010;18:17-22.
9. Yasar M, Bayram A, Dogan M, Sagit M, Kaya A, Ozcan I, et al. Retrospective analysis of surgically managed maxillofacial fractures in Kayseri Training and Research Hospital. Turk Arch Otorhinolaryngol. 2016;54:5-9.
10. Eriksson L, Willmar K. Jaw fractures in Malmo 1952- 62 and 1975-85. Swed Dent J 1987;11:31-36.
11. Erol B, Ozer N, Tanrikulu R, Gulsun B, Atay C. Maxillo-facial fractures: retrospective study of the 2308 cases. Ulus Travma Acil Cerrahi Derg 1998;4:162-7.
12. Oruc M, Isik VM, Kankaya Y, Gursoy K, Sungur N, Aslan G, et al. Analysis of fractured mandible over two decades. J Craniofac Surg 2016;27:1457-61.
13. Ozkaya O, Turgut G, Kayali MU, Ugurlu K, Kuran I, Bas L. A retrospective study on the epidemiology and treatment of maxillofacial fractures. Ulus Travma Acil Cerrahi Derg 2009;15:262-6.
14. Ortakoglu K, Gunaydin Y, Aydintug YS, Bayar GR. An analysis of maxillofacial fractures: a 5-year survey of 157 patients. Mil Med 2004;169:723-7.
15. Ozgenel GY, Bayraktar A, Ozbek S, Akin S, Kahveci R, Ozcan M. [A retrospective analysis of 204 mandibular fractures]. Ulus Travma Acil Cerrahi Derg. 2004;10:47-50.
16. Iatrou I, Samaras C, Theologie-Lygidakis N. Miniplate osteosynthesis for fractures of the edentulous mandible: a clinical study 1989-96. J Craniomaxillofac Surg. 1998;26:400-4.
17. Sauerbier S, Schon R, Otten JE, Schmelzeisen R, Gutwald R. The development of plate osteosynthesis for the treatment of fractures of the mandibular body - a literature review. J Craniomaxillofac Surg. 2008;36:251-9.
18. van den Bergh B, Heymans MW, Duvekot F, Forouzanfar T. Treatment and complications of mandibular fractures: a 10-year analysis. J Craniomaxillofac Surg. 2012;40:e108-111. .Zix JA, Schaller B, Lieger O, Saulacic N, Thoren H, Iizuka T. Incidence, aetiology and pattern of mandibular fractures in central Switzerland. Swiss Med Wkly. 2011;141:w13207.
19. Champy M, Lodde JP, Schmitt R, Jaeger JH, Muster D. Mandibular osteosynthesis by miniature screwed plates via a buccal approach. J Maxillofac Surg. 1978;6:14-21.
20. Paes JV, de Sa Paes FL, Valiati R, de Oliveira MG, Pagnoncelli RM. Retrospective study of prevalence of face fractures in southern Brazil. Indian J Dent Res. 2012;23:80-6.
21. Brasileiro BF, Passeri LA. Epidemiological analysis of maxillofacial fractures in Brazil: a 5-year prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006;102:28-34
22. Kamulegeya A, Lakor F, Kabenge K. Oral maxillofacial fractures seen at a Ugandan Tertiary Hospital: a six-month prospective study. Clinics. 2009;64:843-8.
23. Elgehani RA, Orafi MI. Incidence of mandibular fractures in Eastern part of Libya. Med Oral Patol Oral. 2009;14:E529-E532.
24. Oikarinen K, Ignatius E, Kauppi H, Silvennoinen U. Mandibular fractures in northern Finland in the 1980s--a 10-year study. Br J Oral Maxillofac Surg. 1993;31:23-7.
25. Chrcanovic BR, Abreu MH, Freire-Maia B, Souza LN. 1,454 mandibular fractures: a 3-year study in a hospital in Belo Horizonte, Brazil. J Craniomaxillofac Surg. 2012;40:116-23.
26. Bormann KH, Wild S, Gellrich NC, Kokemuller H, Stuhmer C, Schmelzeisen R et al. Five-year retrospective study of mandibular fractures in Freiburg, Germany: incidence, etiology, treatment, and complications. J Oral Maxillofac Surg. 2009;67:1251-5.
27. Türkiye Analizi: Sürücü ve Ön Koltuk Yolcularinin Emni̇yet Kemeri̇ Kullanimi. T.C. İÇİŞLERİ BAKANLIĞI Emniyet Genel Müdürlüğü. http://www.trafik.gov.tr/SiteAssets/Yayinlar/Kitapl ar/Emniyet_Kemeri_2016.pdf (Accessed 03.10.2018)
28. Fridrich KL, Pena-Velasco G, Olson RA. Changing trends with mandibular fractures: a review of 1,067 cases. J Oral Maxillofac Surg. 1992;50:586-9.
29. Safdar N, Meechan JG. Relationship between fractures of the mandibular angle and the presence and state of eruption of the lower third molar. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1995;79:680-4.
30. Lamphier J, Ziccardi V, Ruvo A, Janel M. Complications of mandibular fractures in an urban teaching center. J Oral Maxillofac Surg. 2003;61:745- 749; discussion 749-750.
31. Cabrini Gabrielli MA, Real Gabrielli MF, Marcantonio E, Hochuli-Vieira E. Fixation of mandibular fractures with 2.0-mm miniplates: review of 191 cases. J Oral Maxillofac Surg. 2003;61:430-6.
32. Olson RA, Fonseca RJ, Zeitler DL, Osbon DB. Fractures of the mandible: a review of 580 cases. J Oral Maxillofac Surg. 1982;40:23-28.
33. Teshome A, Andualem G, Tsegie R, Seifu S. Two years retrospective study of maxillofacial trauma at a tertiary center in North West Ethiopia. BMC Res Notes. 2017;10:373.
34. de Matos FP, Arnez MF, Sverzut CE, Trivellato AE. A retrospective study of mandibular fracture in a 40- month period. Int J Oral Maxillofac Surg. 2010;39:10- 5.
35. Junior SM, Santos SE, Kluppel LE, Asprino L, Moreira RW, de Moraes M. A comparison of motorcycle and bicycle accidents in oral and maxillofacial trauma. J Oral Maxillofac Surg. 2012;70:577-83.
36. Munante-Cardenas JL, Facchina Nunes PH, Passeri LA. Etiology, treatment, and complications of mandibular fractures. J Craniofac Surg. 2015;26:611- 5.
37. Zweig BE. Complications of mandibular fractures. Atlas Oral Maxillofac Surg Clin North Am. 2009;17:93-101.
38. Moulton-Barrett R, Rubinstein AJ, Salzhauer MA, Brown M, Angulo J, Alster C, et al. Complications of mandibular fractures. Ann Plast Surg. 1998;41:258-63.
39. Motamedi MH, Dadgar E, Ebrahimi A, Shirani G, Haghighat A, Jamalpour MR. Pattern of maxillofacial fractures: a 5-year analysis of 8,818 patients. J Trauma Acute Care Surg. 2014;77:630-4.